Objective: This study aims to evaluate the effects of regular follow-up and education on warfarin efficiency, satisfaction, and quality of life in rural patients.

Methods: A total of 133 rural patients who were taking warfarin were followed-up mean of 17.4±0.5 months (mean age 58±13 years, 72.9% female). All patients were educated and follow-up by a single cardiologist prospectively. A list and a picture booklet of foods that interact with warfarin and a follow-up chart were prepared for each patient. An illustrated scheme of pills that should be taken every day was prepared for illiterate patients. The international normalized ratio (INR) values during and one year before the study were recorded from the hospital system, and the time in therapeutic range (TTR) was calculated. The Duke Anticoagulation Satisfaction Scale (DASS) was conducted at the start and end of the study to determine patients’ satisfaction with warfarin use. Furthermore, the Medical Outcomes Study Form 36(SF-36) was used for determining the health-related quality of life (HRQoL).

Results: The 45.9% of patients were illiterate and 33.8% were primary school graduates. The median TTR during follow-up increased significantly compared with the previous year [40.0(IQR 36.5) vs. 62.1(IQR 29.3); p<0.001]. Furthermore, patients with TTR>70% increased significantly (36.8% vs. 21.1%, respectively; p< 0.001). Unfortunately, patients’ HRQoL and satisfaction with warfarin use were found to be deteriorated significantly compared to the basal levels.

Conclusion: We found that the efficiency of warfarin increased significantly but, interestingly, HRQoL and satisfaction with warfarin use deteriorated significantly after regular education and follow-up in rural patients.